{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:05:46Z","timestamp":1790928346223,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Myxofibrosarcomas are notoriously highly infiltrative soft-tissue sarcomas, making negative surgical margins difficult to obtain. Recently, vacuum-assisted closure (VAC) is used to delay wound closure until a negative margin has been achieved; however, this can delay care and increase costs. Our institution has historically performed single-stage resections with intraoperative frozen margin analysis and reconstruction in these patients. The purpose of this study is to report the outcomes of this technique. Methods: We reviewed 112 patients (62 males, mean age 70 \u00b1 14 years) with superficial myxofibrosarcoma. Eighty-eight patients received preoperative radiation. All patients underwent surgical resection with intraoperative frozen margin analysis, and the planned reconstruction was performed in a single anesthetic. Results: The 10-year local recurrence-free survival was 90%; positive intraoperative frozen section (HR 7.44, p = 0.004) and final permanent margins (HR 8.53, p = 0.007) were associated with local recurrence. Intraoperative margins were negative in 103 (92%) of patients, 1 of which was positive on final permanent section. There were nine cases of microscopically positive margins, of which seven underwent immediate re-excision to a negative margin. The accuracy of frozen margin assessment for myxofibrosarcoma was between 92.92 and 98.23%. All patients underwent reconstruction at the time of resection, with 19% needing an additional procedure, most commonly due to a wound complication (12%). Conclusions: Multidisciplinary single-stage excision with intraoperative frozen margin assessment and soft-tissue reconstruction yields low rates of local recurrence in patients with superficial myxofibrosarcoma.<\/jats:p>","DOI":"10.3390\/cancers17223637","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T09:59:09Z","timestamp":1763027949000},"page":"3637","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Staged Reconstruction Is Not Necessary Following Oncologic Resection of Superficial Myxofibrosarcoma"],"prefix":"10.3390","volume":"17","author":[{"given":"Leilani","family":"Garayua-Cruz","sequence":"first","affiliation":[{"name":"School of Medicine, University of Puerto Rico, San Juan, PR 00936, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-4133","authenticated-orcid":false,"given":"Samuel E.","family":"Broida","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaela H.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Folpe","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8747-692X","authenticated-orcid":false,"given":"Meng X.","family":"Welliver","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie N.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven I.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7659-5766","authenticated-orcid":false,"given":"Thanh P.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-6946","authenticated-orcid":false,"given":"Scott H.","family":"Okuno","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Bakri","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L.","family":"Moran","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0390-1018","authenticated-orcid":false,"given":"Matthew T.","family":"Houdek","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref_1","first-page":"200","article-title":"Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine","volume":"70","author":"Gamboa","year":"2020","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1302\/0301-620X.98B12.37568","article-title":"Myxofibrosarcoma of the extremity and trunk","volume":"98-B","author":"Ghazala","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lucarelli, E., De Vita, A., Bellotti, C., Frisoni, T., Vanni, S., Guerrieri, A.N., Pannella, M., Mercatali, L., Gambarotti, M., and Duchi, S. (2023). Modeling Myxofibrosarcoma: Where Do We Stand and What Is Missing?. Cancers, 15.","DOI":"10.3390\/cancers15215132"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.soc.2016.05.008","article-title":"Myxofibrosarcoma","volume":"25","author":"Roland","year":"2016","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/SLA.0b013e3181cf87fa","article-title":"Extremity Soft Tissue Sarcoma in a Series of Patients Treated at a Single Institution","volume":"251","author":"Gronchi","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/830879","article-title":"Prognostic and Survival Factors in Myxofibrosarcomas","volume":"2012","author":"Dewan","year":"2012","journal-title":"Sarcoma"},{"key":"ref_7","first-page":"436","article-title":"The management of myxofibrosarcoma\u2014A ten-year experience in a single specialist centre","volume":"80","author":"Daniels","year":"2014","journal-title":"Acta Orthop Belg"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9171","DOI":"10.1245\/s10434-021-10242-4","article-title":"Temporizing Wound VAC Dressing Until Final Negative Margins are Achieved Reduces Myxofibrosarcoma Local Recurrence","volume":"28","author":"Fourman","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1245\/s10434-023-14839-9","article-title":"Does Wound VAC Temporization Offer Patient-Reported Outcomes Similar to Single-Stage Excision Reconstruction After Myxofibrosarcoma Resection?","volume":"31","author":"Werenski","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1245\/s10434-021-11023-9","article-title":"Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved","volume":"29","author":"Fourman","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/jso.27698","article-title":"Wound vacuum-assisted closure temporization after tumor resection of soft tissue sarcomas\u2014A cost analysis in a propensity-score matched population","volume":"130","author":"Gonzalez","year":"2024","journal-title":"J. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/1097-0142(19860715)58:2<306::AID-CNCR2820580216>3.0.CO;2-7","article-title":"Reproducibility of a histopathologic grading system for adult soft tissue sarcoma","volume":"58","author":"Coindre","year":"1986","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1200\/JCO.1993.11.7.1269","article-title":"Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas","volume":"11","author":"Edmonson","year":"1993","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.4065\/70.12.1137","article-title":"Accuracy of Frozen Section Diagnosis in Surgical Pathology: Review of a 1-Year Experience With 24,880 Cases at Mayo Clinic Rochester","volume":"70","author":"Ferreiro","year":"1995","journal-title":"Mayo Clin. Proc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/j.ejso.2022.01.003","article-title":"Treatment strategies and outcomes of primary Myxofibrosarcomas in a large patients cohort","volume":"48","author":"Radaelli","year":"2022","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chen, W., Ye, M., Sun, Y., Wei, Y., and Huang, Y. (2024). Analysis of clinical factors impacting recurrence in myxofibrosarcoma. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-53606-y"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101485","DOI":"10.1016\/j.adro.2024.101485","article-title":"Myxofibrosarcoma: Outcomes, Prognostic Factors, and Role of Neoadjuvant Radiation Therapy","volume":"9","author":"Abdou","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1844816","DOI":"10.1155\/2021\/1844816","article-title":"Oncological Outcomes in Patients with Appendicular Myxofibrosarcomas: A Retrospective Study","volume":"2021","author":"Lee","year":"2021","journal-title":"J. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/jso.27935","article-title":"Intraoperative Peripheral Frozen Margin Assessment in Soft Tissue Sarcoma","volume":"131","author":"Zeitlinger","year":"2024","journal-title":"J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gong, M.F., Li, W.T., Bhogal, S., Royes, B., Heim, T., Silvaggio, M., Malek, M., Dhupar, R., Lee, S.J., and McGough, R.L. (2023). Intraoperative Evaluation of Soft Tissue Sarcoma Surgical Margins with Indocyanine Green Fluorescence Imaging. Cancers, 15.","DOI":"10.3390\/cancers15030582"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5303","DOI":"10.1245\/s10434-020-08785-z","article-title":"Intraoperative Pathologic Margin Analysis and Re-Excision to Minimize Reoperation for Patients Undergoing Breast-Conserving Surgery","volume":"27","author":"Racz","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.21873\/anticanres.13430","article-title":"Prognostic Factors and Outcomes for Patients With Myxofibrosarcoma: A 13-Year Retrospective Evaluation","volume":"39","author":"Lenze","year":"2019","journal-title":"Anticancer. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/ans.18320","article-title":"Oncologic outcomes in myxofibrosarcomas: The role of a multidisciplinary approach and surgical resection margins","volume":"93","author":"Rhee","year":"2023","journal-title":"ANZ J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vanni, S., De Vita, A., Gurrieri, L., Fausti, V., Miserocchi, G., Spadazzi, C., Liverani, C., Cocchi, C., Calabrese, C., and Bongiovanni, A. (2022). Myxofibrosarcoma landscape: Diagnostic pitfalls, clinical management and future perspectives. Ther. Adv. Med. Oncol., 14.","DOI":"10.1177\/17588359221093973"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.ijrobp.2018.05.055","article-title":"Localized Myxofibrosarcomas: Roles of Surgical Margins and Adjuvant Radiation Therapy","volume":"102","author":"Stoeckle","year":"2018","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/jso.27782","article-title":"The effect of radiation or chemotherapy on the local recurrence, overall survival, and distant metastasis in patients with myxofibrosarcoma: A systematic review","volume":"130","author":"Tibbo","year":"2024","journal-title":"J. Surg. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/22\/3637\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T10:07:02Z","timestamp":1763028422000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/22\/3637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":26,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["cancers17223637"],"URL":"https:\/\/doi.org\/10.3390\/cancers17223637","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]}}}